Individual
JESSICA L PARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
15 SAUNDERS WAY, WESTBROOK, ME 04092
(207) 878-9663
Mailing address
185 BUCK ST, GORHAM, ME 04038-2210
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC16722
ME
1041C0700X
Clinical Social Worker
MC15489
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366786410
—
ME
05
—
1417209826
—
ME
Enumeration date
07/21/2015
Last updated
07/23/2018
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